Tiffany C. Rush-Wilson, PhD
Childhood and adolescent obesity is a problem that impacts members of all races and socioeconomic groups. There are many mental health, psychosocial, and medical consequences that must be made clear to clinicians, parents, and children who are living with obesity. A definition of childhood obesity, signs and symptoms, medication interventions, and future directions of treatment will be discussed in this article.
Introduction
During the past ten years, obesity in the United States has doubled, and currently one in six children is obese. Due largely to this health crisis, we now have a generation of children with a projected life expectancy that is shorter than that of their parents. In the last two decades, the number of children and teens with obesity (ages two to eighteen) increased nearly 300%, with the number of overweight African-American and Hispanic/Latino children increasing dramatically and disproportionately (nearly one-fourth of children from these groups are overweight). These numbers are of epidemic proportions across racial and ethnic groups in this country.
These disconcerting statistics have inspired a media influx of information about eating disorders (including anorexia nervosa, bulimia nervosa, and binge eating), healthy choices in food selection, and exercise. Children, parents, and clinicians, as consumers of food and the media, may have difficulty determining what data to accept and what to further investigate.
Contemporary reports highlight traditional approaches to reducing obesity, including diet and exercise, calorie reduction, and the infusion of fresh fruits and vegetables into children's lives. Criticisms of the reduction and elimination of physical education activities in school curricula, as well as the accessibility of sugary and fattening snacks have also been evident, and the media continues to provide balanced accounts of body size. Controversial treatments - such as using medications intended for purposes other than weight loss, and exercise programs that minimize the importance of cardiovascular activity in favor of strength training - have been gaining attention. Such contradictory information can make decision making difficult.
Childhood Obesity
What is obesity? Simply put, obesity is a condition in which a person's weight is more than 20% greater than is recommended for his or her height and age. Believe it or not, there is no official diagnosis mental health clinicians use to determine the potentially complicated psychological process of overweight in children.
There can be social consequences for children who are overweight. Obese children may endure teasing, difficulties with physical activities, and self-esteem problems related to negative media images. Psychiatric literature about disordered eating has been available in the media and academia for many years. A greater amount of information is now available about how to diagnose, treat, and support children who are overweight.
There is no single cause of obesity. The etiology, or causes, can be complex. Some children's obesity can be traced to medical conditions, chemical sensitivity, or even adrenal gland function. Other causes may be related to psychological, familial, and cultural factors. Modern society places a great deal of emphasis on having an "ideal" body. Marketing ads geared toward children and young adults promote the idea that having a perfect body is associated with having a great life, affluence, an active social life, and many other benefits. Just look at the next toy or music ad and look for the chubby children. They're not there. Children may compare themselves to these images and develop an eating-disordered mentality.
Eating Disorders
There are three primary categories of eating disorders. Anorexia nervosa is a rare syndrome that affects one-half to one percent of the U.S. population of adolescent girls. Symptoms include dramatic weight loss, restrictive eating patterns, and psychological distress. The disorder has been well researched for more than a century. Bulimia nervosa, or the binge-purge syndrome, is more common than anorexia nervosa and affects one to three percent of the adolescent female population in the United States. Although the American Psychiatric Association does not yet officially list Binge Eating Disorder (BED) as an eating disorder, ongoing diagnostic supports this syndrome. People who meet the proposed requirements for BED consume more food and calories than the average person at a sitting and feel guilt about the consumption as well as a lack of control over their eating, but they do not use unhealthy means to get rid of the food. Of the three eating disorders, BED is the most common. Research has estimated that more than one-half to four percent of the population may have this syndrome. Other estimates are higher. Overweight children, who may feel a lack of control over their eating and eat beyond the point of satiety, thereby consuming more calories at a single sitting than the average adult, can suffer from this psychological condition. This overeating is a serious concern. Excessive weight gain can lead to problems with obesity, premature puberty, diabetes, and other medical complications.
While certainly increasing in prevalence, childhood obesity is not new. As a clinician who treats eating disorders, I have seen serious cases of obesity in children, with two being particularly striking. In the 1970s, there were two children in my second-grade class who had severe problems with obesity. Both of these clients were young girls; one was six years old and the other was twelve. From these two cases, I learned two important obesity factors. First, the "clean your plate" rule, a well-meaning standard in both of these girls' lives, can be counterproductive. A six-year-old child has different nutritional needs than an adult. This child, at such a young age, weighed 10 pounds more than is recommended for a 5'2" adult woman. The 12 year old was morbidly obese and used food as a method to self soothe. Her eating practice was ultimately seen as an issue of neglect by social services, and her extreme overweight ultimately became the opening for outside help and support. It was her proverbial cry for help.
Conclusion
So what can you do to help ensure your child is a healthy weight? Here are a few suggestions to get you started.
• If you are concerned about your child's weight, make an appointment with her physician to rule out any physical causes. Discuss your concerns. After a physical examination, your child's physician will be able to make a recommendation about how to proceed. Do not encourage your child to begin a weight modification plan without first consulting a physician.
• Talk to your child about healthy food choices. Help her distinguish between unhealthy popular foods and healthy choices.
• Learn about organic foods. While they are usually more expensive than conventional foods, having fewer chemicals in your child's diet can be beneficial.
• Plan out menus together and encourage your child to participate in meal preparation.
• Convenience foods are a necessity in the lives of many busy families. If it is not feasible to eliminate these from your child's diet, consider incorporating fresh fruits and vegetables and salads into mealtime.
• Model healthy eating and exercise behaviors. Children learn from watching the actions of the influential adults in their lives.
• Talk to your child about the reasons we eat - to nourish ourselves - and help her have an awareness of eating for non-hunger reasons.
• Discuss emotional eating with your child. Talk about ways to identify and express emotions that are not related to food.
• Ensure that your child has a trustworthy adult confidant. Often this person is a parent, trusted relative, teacher, someone affiliated with a religious congregation, or the parent of a close friend. Access to a responsible, trustworthy adult will be a tremendous asset to your child's emotional well being.
• Parents, move your body! Dance with your child, go for walks, and engage in physical activities as a family. Unfortunately children and adolescents have less access to physical education and recess than they did a decade ago. The physical activity that they get at home may be a major component of their overall exercise.
• Encourage your child to join extracurricular activities such as sports, which may help improve her self-esteem and physical health.
• Limit the amount of time your child engages in sedentary activities. While television viewing, video games, Internet usage, and other similar activities can be fun and mentally engaging, they do not promote much physical movement.
• Consider doing a charity walk/ run together. These events often have a children's walk/ run event.
Calculate Your BMI
To calculate your BMI (using English standard measurements), divide your weight in pounds by your height in inches. Use that number and divide it once again by height in inches and then multiply it by 703. A result that is smaller than 18.5 indicates that a person is underweight. A healthy weight range is between BMI scores of 18.5 and 24.9, overweight scores are 25.0-29.9, and obesity scores begin at 30.0.
Dr. Rush-Wilson conducted her graduate training at John Carroll University (MA) and at the University of Akron (PhD). Her master's independent study was on eating disorders. Her doctoral dissertation was a qualitative study on eating disorders among African-American women. The research generated a theory of why women in this group develop and suffer from these disorders. In addition, Dr. Rush-Wilson recently presented at the She currently runs the Chagrin Counseling Associates and Eating Recovery Center.
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